Is C-Reactive Protein a Useful Predictor of Outcome in Peritoneal Dialysis Patients?

Abstract

Abstract. An elevated C-reactive protein (CRP) has recently been shown to be strongly predictive of mortality in hemodialysis patients. However, its predictive value in peritoneal dialysis (PD) patients has not been assessed. A cohort of 50 PD patients was followed prospectively for a 3-yr period, after initial determination of CRP. Patients with an elevated CRP (>6 mg/L;n= 29) had significantly reduced plasma prealbumin (0.36 ± 0.02versus0.44 ± 0.03 g/L;P< 0.05), decreased total weekly creatinine clearance (CCr; 52.5 ± 2.3versus63.1 ± 3.2 L/1.73 m2;P< 0.01), and increased left ventricular thickness (1.24 ± 0.05versus1.08 ± 0.06 cm;P< 0.05) at baseline compared with those who had a normal CRP (≤6 mg/L;n= 21). Baseline CRP (log-transformed) correlated weakly with baseline Kt/V, CCr, and pre-albumin. With the use of a multivariate Cox's proportional hazards model to adjust for potential confounding factors, an elevated CRP was predictive of myocardial infarction (adjusted hazard ratio, 4.8; 95% confidence interval [CI], 1.0 to 23;P= 0.048) and tended to be predictive of fatal myocardial infarction (adjusted hazard ratio, 6.0; 95% CI, 0.8 to 43;P= 0.07). However, CRP was not significantly associated with all-cause mortality (adjusted hazard ratio, 2.1; 95% CI,0.8 to 5.4;P= 0.15). In conclusion, CRP elevation occurs in a substantial proportion of PD patients and is independently predictive of future myocardial infarction. Such patients may warrant closer monitoring and attention to modifiable cardiovascular risk factors.